Imaging Services

Imaging Services

The American Academy of Otolaryngology—Head and Neck Surgery recognizes the importance of quality standards and accreditation for medical imaging and knows that Academy members look to the foundation to provide leadership on this issue. In response to these developments, the Academy has established the Imaging Committee. This committee, chaired by Richard Miyamoto, MD, is charged with providing additional resources and training for continuing medical education in this area and with monitoring continuing legislative and reimbursement developments. Below are recent advocacy efforts related to reimbursement and coverage of CT imaging services.

Additional Information

The Academy’s Health Policy team worked with the Imaging Committee and coordinated with the IAC to submit comments to Coventry / National Imaging Associates (NIA), Humana, and Blue Cross Blue Shield of Idaho opposing their policies that restrict the use of mini-CT scans and/or limit the ability for otolaryngologists to interpret and provide imaging services. The letters incorporates language from AAO-HNSF’s position statement on point-of-care imaging to support providers who utilize point-of-care imaging when medically necessary and appropriate, in order to improve efficiency in diagnosing and managing a patient’s condition.

In addition, in response to Humana’s request for additional evidence in specific criteria where computer assisted navigation is needed, comments were submitted to Humana’s Medical Director with updated references added to the AAO-HNS/F position statement on Intra-Operative Use of Computer Aided Surgery. While their medical policy on Computer Assisted Surgical Navigation (CASN) currently does not provide payment for the service, Humana stated that they are willing to review any new information provided on this topic. While we are hopeful that these policies will be changed to allow for coverage, the Academy is appreciative of the open channels of communication with these payers.

State Advocacy Efforts in California Leads to Defeat of Bill to Remove Stark Law Exemption(4/1/2014)

At a state level, in April the AAO-HNS was approached by the CPCI regarding a sign-on letter opposing California Senate Bill 1215 which would have removed the exemption for in-office advanced imaging. The Academy’s Government Affairs team moved quickly to receive support from the California Otolaryngology Society and San Diego Academy of Otolaryngology Bergeron), as well as the AAO-HNS to sign on to the opposition letter. The California Medical Association also took action to oppose the bill. Thanks go to Board of Governors and California Otolaryngology Society leaders Marci Bothwell, MD,Christopher Bergeron, MD, and Steven Kmucha, MD, JD for their local advocacy efforts. As a result of these actions, SB 1215 was defeated in the California Senate Business, Professions and Economic Development Committee and it is dead for the year.

Physician Community Urges Congress to Preserve Stark Law Exemption(3/27/2014) On a national level, on March 18, the AAO-HNS joined the Coalition on Patient-Centered Imaging in sending a letter to Congress urging preservation of the in-office ancillary services exception (IOASE) to the “Stark” law and rejection of the Administration’s budget proposal to restrict the IOASE. Leaders of the Senate Finance, House Ways & Means, and Energy & Commerce Committees received the letter. Click here to view the letter.

Several states, such as California and Texas, have implemented rules or laws which mandate adherence to CT and interventional radiography imaging guidelines for healthcare providers. Awareness of radiation dose safety has increased tremendously, and continues to gain momentum among state legislatures. To view further information about the law passed in Texas, click here. To view California's Information Notice on this legislation from 2010 and its amendment in 2012, click here.

In Connecticut, a bill (Raised Bill No. 2463) similar to California's legislation on this issue was proposed but was referred to the Joint Committee on Public Health and did not receive a hearing. If reintroduced for the 2014 legislative session, the bill would:

• Require providers to record CT radiation dose in patient radiology reports • Require annual inspection of CT scanners to ensure displayed dose doesn’t deviate more than 20% from actual measured dose • Mandate five days for reporting to the state and referring physician and 15 days for reporting to patients certain error events (e.g. repeat CT raising cumulative dose to an excessive level, wrong site, permanent damage to patient caused by dose) when dose thresholds, to be established by the Commissioner of Public Health, are exceeded

The Health Policy team will continue to monitor this issue in the coming months. If similar legislation is introduced in your state, please contact the Health Policy team.

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Appropriateness Criteria

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Academy Attends Appropriateness Use Criteria (AUC) Meeting(2/4/2015)This month HP staff attended a specialty briefing sponsored by the AMA on the Appropriateness Use Criteria (AUC) program mandated in the Protecting Access to Medicare Act (PAMA) of 2014. Specialty society representatives discussed AUC and the potential expansion of preauthorization requirements in Medicare which could impact otolaryngology. To read an expanded summary of the meeting, click here.

Academy Representation on the American College of Radiology Appropriateness Criteria® (AC) Expert Panels on Neurologic Imaging(5/30/14)The ACR Committee on Diagnostic/Interventional Appropriateness Criteria invited AAO-HNS to select a new representative on the American College of Radiology Appropriateness Criteria® (AC) Expert Panels on Neurologic Imaging. To note, AC are evidence-based guidance used by providers in making the most appropriate imaging or treatment decision for a specified medical condition. The ACR feels the expertise of AAO-HNS members contributes to producing stronger, more relevant recommendations. The AAO-HNS greatly appreciates the opportunity to participate in the process of reviewing and updating relevant AC to otolaryngologists.

As of June 2014, David Conley, MD will replace Brian Nussenbaum, MD as an AAO-HNS representative to the ACR AC Expert Panel on Neurologic Imaging. We greatly appreciate all the time and effort that Dr. Nussenbaum has given over the past several years in this role. Dr. Conley will work with the panel to develop and update topics for select neurological conditions.

ACR Releases New and Updated Appropriateness Criteria(12/12/2013) The American College of Radiology has released new and revised Appropriateness Criteria (ACR AC). More than 80 physicians from specialties participate in the development and review of the topics which includes 29 updated, and 12 new, topics from various expert panels. AAO- HNSF Imaging Committee and Academy members serve as Expert Panel members of the ACR AC, particularly for Neurologic Imaging Criteria. Academy members, including Brian Nussenbaum, MD, Brad Kesser, MD (specialty reviewer for new updated hearing loss/vertigo diagnostic imaging), and James Hadley, MD (specialty reviewer for Orbits, Vision and Visual Loss, Sinusitis-Child, Headache, and Cerebrovascular Disease) have contributed to the review and update of the ACR AC, particularly for Neurologic Imaging Criteria. The AAO-HNSF Imaging Committee has also given input to revisions on Sinonasal Disease, amongst other clinical condition topics. Click here to access the full library of ACR AC.

Academy Representation on the Intersocietal Accreditation Commission (IAC) CT Division (IAC-CT)(5/30/14)As a follow-up to the Academy’s submission of several nominees for the open seat on the Intersocietal Accreditation Commission (IAC) CT Division (IAC-CT), Rakesh Chandra, MD, Academy member from Northwestern University Feinberg School of Medicine, and Imaging Committee member, has been elected to the IAC CT board of directors. The CT board was impressed by Dr. Chandra’s level of expertise and knowledge and looks forward to working together to help further the mission and importance of IAC accreditation.

National Forum: Exploring the Value of IAC Accreditation(10/24/2013)The AAO-HNS was one of the original sponsoring organizations of the Intersocietal Accreditation Commission (IAC) and has been involved in developing and maintaining CT imaging accreditation standards since its inception, with Gavin Setzen, MD, the President of the Intersocietal Accreditation Commission CT Division (IAC-CT). On October 29th, the IAC is hosting the first of its kind Forum held in Washington, DC, including representatives from specialties involved in CT imaging, government agencies, including the FDA, CMS, GAO, private payers, as well as public service organizations. CT accreditation is important because it helps to ensure optimal quality and standardization of testing and reporting in CT imaging, and also helps to ensure that the clinician is providing the right test at the right time on the right patient. Also, the Centers for Medicare & Medicaid requires accreditation of facilities that furnish advanced imaging services, including CT, in order to receive reimbursement for services provided to Medicare patients. This Forum is an exciting opportunity for all stakeholders to meet face-to-face to share opinions and recommendations to make accreditation more meaningful. David Nielsen, MD, AAO-HNS CEO and EVP, Richard Waguespack, MD, AAO-HNS President, and Gavin Setzen, MD, AAO-HNS Secretary-Treasurer will attend the meeting to provide comments on a sponsoring organization’s perspective on the strengths and weaknesses of the current accreditation model.